Salbutamol-induced severe lactic acidosis in acute asthma

Abstract

Selective beta-adrenoceptor agonists are worldwide prescribed to manage bronchial obstruction. However, they expose to a potential risk of hyperlactatemia and lactic acidosis even with normal doses. The mechanism still poorly understood and suggested that salbutamol diverts the metabolism of pyruvate acid from Krebs cycle toward lactate formation. We report the case of a 42-year-old patient, admitted to intensive care unit for acute severe asthma. He presented a transient lactic acidosis over the first 48 h, following an excessive use of salbutamol. The metabolic acidosis caused tachypnea, as a compensatory mechanism, leading to respiratory failure. The diagnosis of salbutamol-induced lactic acidosis must be made by elimination and only accepted after deleting the other causes. The main clinical character is the worsening of dyspnea despite regression of bronchospasm. It is transient and usually normalizes within 24–48 h after stopping or decreasing doses of salbutamol.

From Bronchodilation to Lactic Acidosis: A Case Report on Salbutamol’s Adverse Effect

“…Hypokalaemia, in addition to metabolic acidosis and hyperlactacidemia, may increase the suspicion of a SABA adverse effect. In specific situations, using spirometry to measure peak flow can help in distinguishing between salbutamol-induced lactic acidosis (improvement of peak flow) and lactic acidosis secondary to hypoxemia/acute deterioration (decrease in peak flow rate) [1].…”

“…In cases of acute severe asthma, elevated blood lactate levels can also and most frequently arise from several factors: hypoxemia, inadequate tissue oxygen delivery due to hypotension, and overproduction by respiratory muscles due to increased workload. The timely recognition and adequate etiological management of lactic acidosis are fundamental for optimal outcomes [1,3]. We report a case of lactic acidosis in a patient with asthma exacerbation in the absence of tissue hypoperfusion and highlight the difficulties in the management and treatment of acute asthma exacerbations in this setting.…”

“…Short-acting β2 agonists (SABA), including salbutamol, in combination with ipratropium bromide and oral/intravenous corticosteroids, remain one of the most used bronchodilator agents for acute asthma treatment. Nevertheless, this pharmacological class can be responsible for adverse effects, including lactic acidosis [1,2].…”

Báo Cáo Ca Lâm Sàng: Toan Lactic Do Salbutamol Ở Bệnh Nhân Đợt Cấp Bệnh Phổi Tắc Nghẽn Mạn Tính

“…Tuy nhiên, sử dụng thuốc có nguy cơ làm tăng lactate máu và nhiễm acid lactic ngay cả với liều thông thường. Cơ chế là do quá trình salbutamol chuyển hướng chuyển hóa pyruvate từ chu trình Krebs sang sự hình thành lactate [1]. Tăng lactate gây thở nhanh (như một cơ chế bù trừ), dẫn tới tình trạng suy hô hấp.…”

“…Lượng lactate này có thể chuyển thành pyruvate, sau đó đi vào chu trình Krebs. Ngoài ra, lactate còn được dùng để tân tạo đường ở gan và thận (chu trình Cori) [1]. Sự cân bằng giữa sản xuất và thanh thải lactate giữ cho nồng độ lactate máu ít khi > 1 mmol/l.…”